Abstract
Numerous studies have investigated brain changes associated with interventions targeting a range of language problems in patients with aphasia. We strive to integrate the results of these studies to examine (1) whether the focus of the intervention (i.e., phonology, semantics, orthography, syntax, or rhythmic-melodic) determines in which brain regions changes occur; and (2a) whether the most consistent changes occur within the language network or outside, and (2b) whether these are related to individual differences in language outcomes. The results of 32 studies with 204 unique patients were considered. Concerning (1), the location of treatment-related changes does not clearly depend on the type of language processing targeted. However, there is some support that rhythmic-melodic training has more impact on the right hemisphere than linguistic training. Concerning (2), we observed that language recovery is not only associated with changes in traditional language-related structures in the left hemisphere and homolog regions in the right hemisphere, but also with more medial and subcortical changes (e.g., precuneus and basal ganglia). Although it is difficult to draw strong conclusions, because there is a lack of systematic large-scale studies on this topic, this review highlights the need for an integrated approach to investigate how language interventions impact on the brain. Future studies need to focus on larger samples preserving subject-specific information (e.g., lesion effects) to cope with the inherent heterogeneity of stroke-induced aphasia. In addition, recovery-related changes in whole-brain connectivity patterns need more investigation to provide a comprehensive neural account of treatment-related brain plasticity and language recovery.
Highlights
Aphasia is an acquired neurological language disorder affecting approximately 1 in 250 people (NIDCD, 2015)
From the above discussion in Neural differences within linguistic interventions, it seems that most brain regions with treatment-related changes were not specific to a particular type of language intervention
The interventions focusing on semantic, phonological, orthographic, and syntactic processing seemed to elicit brain changes in both hemispheres. This right-hemispheric involvement in treatments classically targeting the left hemisphere could point to compensatory mechanisms after left-hemispheric brain damage. (For a review see Cocquyt, De Ley, Santens, Van Borsel, & De Letter, 2017.) This right-hemispheric compensation typically takes place in brain regions homologous to language regions in the left hemisphere or in regions involved in more general cognitive functions
Summary
Aphasia is an acquired neurological language disorder affecting approximately 1 in 250 people (NIDCD, 2015). This is most commonly caused by a cerebrovascular accident in the languagedominant hemisphere, which is the left hemisphere in more than 90% of right-handed persons (Rasmussen & Milner, 1977). Aphasia results in impaired production and/or impaired comprehension of speech, reading, and/or writing. These communication impairments dramatically affect societal participation and integration, causing a substantial decrease in the quality of life (Dahlberg et al, 2006). Depending on the affected speech and language components, patients are trained on the production and/or comprehension of the meaning of words and sentences
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